How to "Unfreeze" a Frozen Shoulder

Understanding risk factors and treatment for this painful condition

A description of frozen shoulder first appeared in medical literature nearly 150 years ago. Despite long-time awareness, its pathology remains murky.

What Is Frozen Shoulder?

To understand frozen shoulder or adhesive capsulitis—a condition that limits the shoulder's range of motion—it's important to understand the anatomy of the joint. The shoulder, or glenohumeral joint, is made up of a capsule filled with ligaments that attach the shoulder bones together. When this joint becomes inflamed, as happens with frozen shoulder, it becomes painful to move your shoulder. Frozen shoulder is reported to affect 2–5% of the population.

Results from biopsy suggest that this condition begins as a chronic inflammatory condition followed by fibrosis and fibroblast proliferation. This proliferation is likely immunomodulated, or altered via the immune system. (The pathology of frozen shoulder is likely similar to Dupuytren's contracture, another fibrotic condition which affects the fingers.)

Frozen shoulder is usually diagnosed by a physician after a physical exam. Often, diagnostic imaging modalities like x-rays provide little confirmation of this diagnosis although MRI and ultrasound can show soft tissue changes like ligament thickening.

Risk Factors for Frozen Shoulder

In most people, frozen shoulder is idiopathic, meaning it stems from an unknown cause. That said, certain risk factors likely play a role in this condition including:

  • Shoulder injury or surgery
  • Diabetes
  • Cervical disease of the neck
  • Thyroid problems
  • Open heart surgery

Differential Diagnosis for Frozen Shoulder

Because the diagnosis of frozen shoulder primarily relies on clinical exam findings, differential diagnoses or other shoulder pathology must be considered. Here is a list of diseases that present like frozen shoulder:

Treatment for Frozen Shoulder

It's important to first diagnose and treat any underlying risk factors for frozen shoulders like diabetes and thyroid disease.

Because the frozen shoulder is painful, pain management with drugs like NSAIDs or steroids are often prescribed. Of note, steroids provide short-term pain relief of frozen shoulder and can either be injected into the shoulder joint or taken by mouth.

When all other treatment fails, manipulation of the shoulder joint under anesthesia or arthroscopic surgery or open capsular release are last options. After surgery, it's imperative that you participate in physical rehabilitation in order to keep the frozen shoulder from recurring.

While treatment can fast-track healing, frozen shoulder usually goes away with time—within two to four years—and sometimes pain can decrease in just a couple of days. Ultimately, in 90% of all people, the disease remits. If left untreated, frozen shoulder can persist up to three years.

A Word From Verywell

If you or someone you love suffers from what appears to be a frozen shoulder, see a physician immediately since early treatment can prevent future stiffness, especially if you have diabetes or thyroid disease. If further tests and exams are needed, your primary care physician may refer you to a rheumatologist or orthopedic surgeon.

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Article Sources

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  1. D'orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis: a review. Muscles Ligaments Tendons J. 2012;2(2):70-8.

  2. Akbar M, Mclean M, Garcia-melchor E, et al. Fibroblast activation and inflammation in frozen shoulder. PLoS ONE. 2019;14(4):e0215301. doi:10.1371/journal.pone.0215301

  3. Ferri FF. Frozen shoulder. Ferri's Clinical Advisor 2017. Page 487. 2017.

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